Stroescu Ramona, Comsa Serban, Chisavu Flavia, Gafencu Mihai
"Victor Babes" University of Medicine and Pharmacy, Timișoara, Romania.
4th Pediatric Clinic, "Louis Țurcanu" Children's Clinical Sand Emergency Hospital, Timișoara, Romania.
Front Surg. 2024 Mar 19;11:1181802. doi: 10.3389/fsurg.2024.1181802. eCollection 2024.
Paediatric vascular access is a demanding field. The need for a multidisciplinary team is mandatory in children with end-stage kidney disease (ESKD). Central venous catheters (CVCs) remain the preferred option worldwide. Recent emerging data demonstrated the benefits of using arteriovenous fistulas (AVFs) in the paediatric population for long-term vascular access. The small vessel size in children represents a surgical challenge for vascular access.
We report three cases from our haemodialysis department and the difficulty in maintaining permanent vascular access. The first case is an adolescent girl who required a change in vascular approach after multiple central venous catheter (CVC) infections and catheter thrombosis secondary to thrombophilia. Three AVFs were performed but failure occurred early. The patient was also diagnosed with a complex vascular thrombosis with total occlusion of the inferior vena cava and completed distal thrombosis of the superior vena cava. A permanent CVC was placed in the right jugular vein with the tip in the azygos vein. The second case is of an adolescent boy with systemic vasculitis with multiple CVC infections secondary to immunosuppression. The first thrombosis of two right AVFs occurred early with the development of a pseudo-aneurysm that required surgical intervention. The left brachial-cephalic fistula required surgery for closing the collaterals, repositioning and superficialisation. The third case is an adolescent boy with one surgical stage brachial-basilic left AVF and difficulties in venous puncturing.
Vascular access in paediatric haemodialysis remains a demanding field. There is a need for a multidisciplinary team, consisting of a vascular surgeon and an interventional radiologist specialising in children.
儿科血管通路是一个要求很高的领域。对于终末期肾病（ESKD）患儿，多学科团队的参与是必不可少的。中心静脉导管（CVC）在全球范围内仍然是首选的选择。最近出现的数据表明，在儿科人群中使用动静脉内瘘（AVF）进行长期血管通路有诸多益处。儿童血管管径较小，这对血管通路构成了手术挑战。
我们报告了来自血液透析科的三例病例以及维持永久性血管通路的困难。第一例是一名青春期女孩，因多次中心静脉导管（CVC）感染以及继发于易栓症的导管血栓形成，需要改变血管通路方法。进行了三次动静脉内瘘（AVF）手术，但早期均失败。该患者还被诊断为复杂的血管血栓形成，下腔静脉完全闭塞，上腔静脉远端血栓形成。在右颈静脉置入了一根永久性中心静脉导管（CVC），尖端位于奇静脉。第二例是一名患有系统性血管炎的青春期男孩，因免疫抑制继发多次中心静脉导管（CVC）感染。右侧两个动静脉内瘘（AVF）早期出现首次血栓形成，并发展为假性动脉瘤，需要手术干预。左侧头臂动静脉内瘘需要手术来闭合侧支、重新定位并使其浅表化。第三例是一名青春期男孩，有一个一期手术的左肱动脉-贵要静脉动静脉内瘘（AVF），静脉穿刺存在困难。
儿科血液透析中的血管通路仍然是一个要求很高的领域。需要一个由血管外科医生和专门从事儿童治疗的介入放射科医生组成的多学科团队。
